Patients’ access to doctors’ notes proves beneficial

Patients with access to notes written by their physicians feel more in control of their care and report a better understanding of their medical issues, improved recall of their care plan and a greater likelihood of taking their medications as prescribed, according to a study.

Physicians participating in the OpenNotes trial at Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Danville, Pa., and Harborview Medical Center in Seattle reported that most of their fears about an additional time burden and offending or worrying patients did not materialize, and many reported enhanced trust and communication with their patients.

"Patients are enthusiastic about open access to their primary care doctors’ notes," Tom Delbanco, MD, a co-first author of the study and a primary care physician at BIDMC, said in a news release.

Delbanco, also the Koplow-Tullis Professor of General Medicine and Primary Care at Harvard Medical School, said more than 85% of patients reported reading the notes and 99% of those completing the survey wanted continued access to their visit notes.

"Open notes may both engage patients far more actively in their care and enhance safety when the patient reviews their records with a second set of eyes," Delbanco said.

Jan Walker, RN, MBA, co-first author of the study and a principal associate in medicine in the Division of General Medicine and Primary Care at BIDMC and Harvard Medical School, said a key finding was that a substantial number of patients reported becoming more likely to take medications as prescribed. "And in contrast to the fears of many doctors, few patients reported being confused, worried or offended by what they read."

The findings reflect the views of 105 primary care physicians and 13,564 of their patients who had at least one note available during a year-long voluntary program that provided patients at an urban academic medical center, a predominantly rural network of physicians and an urban safety net hospital with electronic links to their doctors’ notes.

Of 5,391 patients who opened at least one note and returned surveys, between 77% and 87% reported open notes made them feel more in control of their care, with 60% to 78% reporting increased adherence to medications. Only 1% to 8% of patients reported worry, confusion or offense. Three of five felt they should be able to add comments to their doctors’ notes, and 86% agreed that availability of notes would influence their choice of providers in the future.

Among physicians, a maximum of 5% reported longer visits, and no more than 8% said they spent extra time addressing patients’ questions outside of visits. A maximum of 21% reported taking more time to write notes, while between 3% and 36% reported changing documentation content.

No physician elected to stop providing access to notes after the experimental period ended.

"The benefits were achieved with far less impact on the work life of doctors and their staffs than anticipated," Delbanco said. "While a sizeable minority reported changing the way their notes addressed substance abuse, mental health issues, malignancies and obesity, a smaller minority spent more time preparing their notes, and some commented that they were improved."

Walker suggested that so few patients were worried, confused or offended by the note because "fear or uncertainty of what’s in a doctor’s black box may engender far more anxiety than what is actually written, and patients who are especially likely to react negatively to notes may self-select not to read them.

"We anticipate that some patients may be disturbed in the short term by reading their notes and doctors will need to work with patients to prevent such harms, ideally by talking frankly with them or agreeing proactively that some things are at times best left unread."